Categorization of household drinking water and sanitation service levels and associated determinants in Uganda.

Achieving universal access to safe drinking water and sanitation remains a major challenge in Uganda, where persistent socioeconomic and spatial inequalities limit progress toward Sustainable Development Goal 6. While previous studies have largely focused on localized settings, national-level evidence applying the WHO/UNICEF Joint Monitoring Programme (JMP) service ladder framework is limited. This study aimed to address this gap. This study used secondary data from the 2018–2019 Uganda Malaria Indicator Survey. A total of 8,925 households were included, with data drawn from the Household Recode file. The dependent variables were household sources of drinking water and types of toilet facilities and these were classified according to the WHO/UNICEF JMP service ladder framework into safely managed, basic, limited, unimproved, and no service categories. Independent variables comprised a range of individual and household-level characteristics. Descriptive statistics were used to summarize key variables, while chi-square tests examined bivariate associations between the dependent and independent variables. Multivariable ordinal logistic regression was then applied to estimate the adjusted effects of the determinants on water and sanitation service levels. All analyses accounted for the complex survey design and sampling weights and were conducted using Stata version 18. Most Ugandan households relied on basic drinking water services (67.8%), while safely managed water remained low (8.8%) and was almost absent in regions such as Karamoja. Sanitation access was dominated by limited services (49.7%), with only 43.6% achieving safely managed sanitation. The significant determinants associated with JMP service levels were identified. Higher education, household wealth, male headship, and residence in central and western regions strongly increased the likelihood of accessing higher service levels. Rural areas and refugee settlements consistently exhibited the lowest service levels, reflecting structural deficits in infrastructure, affordability, and service reliability. This study shows that safely managed drinking water and sanitation remain limited in Uganda, with persistent inequalities driven by education, wealth, gender, and region. Targeted investments and pro-poor, equity-focused policies are urgently needed to improve service levels in underserved rural areas and refugee settlements. Strengthening infrastructure, reducing affordability barriers, and supporting context-specific water and sanitation programming will be essential for accelerating progress toward universal and safely managed services.